Delaney Tessa M, Helvey Jason T, Shiffermiller Jason F
College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
Department of Radiology, University of Nebraska Medical Center, Omaha, NE, USA.
Am J Case Rep. 2020 Feb 15;21:e920016. doi: 10.12659/AJCR.920016.
BACKGROUND Over-the-counter medications that contain aspirin are widely used, and patients generally regard them as safe. However, the side effects of salicylate toxicity can be severe, and delay in the diagnosis may increase the risk of mortality. Neurologic symptoms are a common presenting feature of salicylate toxicity in the elderly, and their recognition may allow earlier diagnosis. This report is of a case of a 61-year-old woman who presented with acute focal neurologic deficit associated with salicylate toxicity and who had a previous history of stroke. CASE REPORT A 61-year-old woman presented to the Emergency Department after awakening with left-sided weakness. She had a history of ischemic stroke with an associated seizure disorder. The patient denied recent seizure, and brain magnetic resonance imaging (MRI) showed no evidence of an acute stroke. Following her arrival, she became acutely confused and complained of tinnitus, shortness of breath, and blurred vision. On direct questioning, she gave a history of excessive use of salicylate for the previous two to three weeks. Her initial serum salicylate level was significantly increased at 78.1 mg/dl (upper therapeutic limit, 19.9 mg/dl). She recovered completely following treatment with oral activated charcoal, intravenous sodium bicarbonate, and potassium replacement. CONCLUSIONS This case demonstrates that physicians should consider salicylate toxicity as a possible cause of exacerbation of neurological deficit in elderly patients.
含有阿司匹林的非处方药物被广泛使用，患者通常认为它们是安全的。然而，水杨酸盐中毒的副作用可能很严重，诊断延迟可能会增加死亡风险。神经系统症状是老年人水杨酸盐中毒常见的表现特征，识别这些症状可能有助于早期诊断。本报告介绍了一例61岁女性病例，该患者出现与水杨酸盐中毒相关的急性局灶性神经功能缺损，且既往有中风病史。病例报告：一名61岁女性在醒来后出现左侧肢体无力，随后被送往急诊科。她有缺血性中风病史并伴有癫痫发作障碍。患者否认近期有癫痫发作，脑部磁共振成像（MRI）未显示急性中风的迹象。到达医院后，她突然变得神志不清，并主诉耳鸣、呼吸急促和视力模糊。经直接询问，她承认在过去两到三周内过量使用了水杨酸盐。她最初的血清水杨酸盐水平显著升高，达到78.1mg/dl（治疗上限为19.9mg/dl）。经过口服活性炭、静脉注射碳酸氢钠和补钾治疗后，她完全康复。结论：该病例表明，医生应将水杨酸盐中毒视为老年患者神经功能缺损加重的可能原因。
